Abstract
Objective
To
determine the impact of smoking on the rate of pulmonary and upper
respiratory complications following laparoscopic gynecologic surgery.
Methods
We
retrospectively identified all patients who underwent laparoscopic
gynecologic surgery at one institution between January 2000 and January
2009. Pulmonary and upper respiratory complications were defined as
atelectasis, pneumonia, upper respiratory infection, acute respiratory
failure, hypoxemia, pneumothorax, or pneumomediastinum occurring within
30 days after surgery
Results
Nine hundred
three patients underwent attempt at laparoscopic surgery. Fifty-four
were excluded because of conversion to laparotomy and 31 because of
insufficient data. Of the 818 patients included, 356 (43%) had cancer. A
total of 576 (70%) patients were never smokers, 156 (19%) were past
smokers, and 86 (10%) were current smokers (smoked within 6 weeks before
surgery). These three groups were similar with regard to median body
mass index, operative time, and length of hospital stay. Compared to
never and past smokers, current smokers were more likely to undergo
high-complexity laparoscopic procedures (10.4%, 15.4%, and 19.8%,
respectively; p = 0.015) and had younger median age 49 years, 51 years,
and 46 years, respectively; p = 0.035. Nineteen (2.3%) patients
experienced pulmonary complications — symptomatic atelectasis (n = 9),
pneumonia (n = 5), acute respiratory failure (n = 2), hypoxemia (n = 1),
pneumomediastinum (n = 1), and pneumothorax (n = 2). The rate of
pulmonary complications was 2.1% (12 of 564 patients) in never smokers,
4.5% (7 of 156 patients) in past smokers, and zero in current smokers.
Conclusion
In
this cohort, smoking history did not appear to impact postoperative
pulmonary and upper respiratory complications. In smokers scheduled for
operative procedures, laparoscopy should be considered when feasible.
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